Anyone had 3 valve replacement surgeries?

Gail in Ca said:

I had my wires removed after the 2nd and 3rd surgeries, within a year of the surgeries because they protruded and bugged me, and my surgeon was fine with my removal request.

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pellicle said:

Morning



for whatever reason I read this article about the ATS some time back (I have the full text, because some time back I worked in a University Library).

https://pubmed.ncbi.nlm.nih.gov/16928497/

now bear in mind that it is not related to your situation (nor mine) because it is specifically about the 19mm valve size.

Before going further I want to make clear the following points:

• I am not any expert in the haemodynamics of how blood flows around a mechanical valve leaflet and all of the many aspects which must be traded off against one another to make a valve "ideal" (note: none are)
• an important part of this opening and closing jet pressures (to my understanding is turbulence is less so) for these produce pressure sufficient to begin to trigger platelets which will then lead to their aggregation and the formation of floating emboli (aka clots)
• to restate the first point in a different way I can not make any conclusions about the difference between opening and closing angles and their pros and cons in the body

So having said that I found the article interesting for the following things (which are not restricted to the 19mm valve issue in question):

Leaflet opening angles of ATS valves in vivo tend to be less than those reported by the manufacturer, and there is a wide variation in opening angles even among valves of the same size.


ATS valves 21 mm or larger (72.2° ± 3.8° in 21-mm, 72.4° ± 2.8° in 23-mm, and 72.8° ± 2.9° in 25-mm valves). {pellicle: note this variation is different from the figures obtained by the study I mentioned above. This is something to keep in mind; not all studies give the same measurements}

This image helps one to understand the geometry of the opening and closing measurements and how they are obtained.

View attachment 890282

worthy of note is the difference in trimming of the wire ties in the above image.

lastly, this is my own X-Ray of my wire state post sugery (and pre my debridement from infection surgeries).
View attachment 890283
Yellow circles give examples of various metal junk left lying around from god only knows which of my 3 surgeries (I suspect #1 more than #3)
Note also the traces of old wires which remain "trapped in the bone" as leftovers from the two prior surgeries. 20 years of being there means "staying there".

A point to consider (which I did) is: what happens if an infection in the chest finds those place to hide in ... answer = "they remove the whole bone. We have had members here undergo this (and one of my friends fathers underwent this exact solution to an infection issue.

This is part of the risks of why you don't want to plan for multiple OHS.


HTH

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Earthsciencerocks said:

I have 10! Seems like a lot. No?

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pellicle said:

you have 10 sternal wires?

wow ... xray? (cos, like wow)

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Earthsciencerocks said:

I can’t hear clicking,

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pellicle said:

a good article and I just wanted to say that the genes you inherit are usually going to express themselves (especially mitochondrial ones) pretty much consistently after you've passsed from embryo to born. There are a few exceptions and we are of course still learning.

The reason why none of that has found its way into clinical practice are (in my view)

1. ethical issues surrounding genetic testing
2. we could just measure and know

however all of that Cytochrome P450 stuff is why you don't drink grapefruit juice on any medication.
https://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html

Best wishes

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Eva said:

I have two St. Jude’s valves, and I hardly hear them myself.

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pellicle said:

interestingly just the other day, I was in getting an Echo done and the technician (woman) asked me "do you have a bio" ... I paused and said something about isn't that on the file?

She replied yes, but said "its very quiet".

I replied I'm lying on the quiet side, wait till I roll over.

After I had to do the other side, she then said "I had a woman in here who had two mechanical valves" and that was much louder than you, and with really different sounds"

I remarked (in a questioning tone) ; what, like some kid practicing the castanets?

We had to have a small break as her 5yo kids just started playing some percussion instrument...

So apparently yes, like castanets

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